E-Prescribing Incentive Program

Under the E-Prescribing Incentive Program, physicians may increase their total Medicare payments by successfully submitting prescriptions electronically (E-Prescribing or eRx).

Physicians who earn the eRx incentive payment will not be eligible for the "meaningful use" of Electronic Health Records (EHRs) incentive payments and vice-versa. This is because the "meaningful use" rules require eRx. Click here for the schedule of payment incentives and penalties for both eRx and "meaningful use" of EHRs.

This presentation (Overview of eRx) provides an overview of the Medicare eRx Incentive Program and includes a brief program background, a look at the program website and documentation, high-level steps on how to get started, available resource, and who to contact for help. 

Payment Adjustment (2013, 2014)

Eligible professionals (EPs) who are not successful electronic prescribers for a designated reporting period shall receive a percentage less (payment adjustment) than the fully allotted amount for covered professional services provided by the Medicare Physician Fee Schedule (MPFS).

Payment adjustments under the eRx Incentive Program are as follows:

• 1.0 percent adjustment in 2012
• 1.5 percent adjustment in 2013
• 2.0 percent adjustment in 2014

Download Free E-prescribing Software: This may be a good option for practices that do not wish to invest a lot of money in a standalone eRx system but need 1) a short term solution that avoids the 2012 eRx payment penalty and 2) time to implement an EHR system that includes an eRx component.

Exclusion Criteria for Payment Adjustments for Individual Eligible Professionals

2013 Payment Adjustment Exclusion Criteria  

Payment adjustment will not apply to individual EPs in 2013 if one of the following criteria are met.

1. The EP is a successful electronic prescriber during the 2011 eRx 12-month reporting period (January 1, 2011 - December 31, 2011).
2. The EP is not an MD, DO, podiatrist, Nurse Practitioner, or Physician Assistant by June 30, 2012; based on primary taxonomy code in the National Plan and Provider Enumeration System (NPPES).
3. The EP does not have at least 100 MPFS cases containing an encounter code in the measure's denominator for dates of service from January 1, 2011 - June 30, 2012.
4. The EP does not have 10 percent or more of their MPFS allowable charges (per Tax Identification Number) for encounter codes in the measure's denominator for dates of service from January 1, 2011 - June 30, 2012.
5. The EP does not have prescribing privileges and reported G8644 on a billable Medicare Part B service at least once on a claim between January 1, 2012 - June 30, 2012.

2014 Payment Adjustment Exclusion Criteria 

Payment adjustment will not apply to individual EPs in 2014 if one of the following criteria are met.

1. The EP is a successful electronic prescriber during the 2012 eRx 12-month reporting period (January 1,2012 - December 31, 2012.
2. The EP is not an MD, DO, podiatrist, Nurse Practitioner, or Physician Assistant by June 30, 2013, based on primary taxonomy code in the NPPES.
3. The EP does not have at least 100 MPFS cases containing an encounter code in the measure’s denominator for dates of service from January 1, 2013 - June 30, 2013.
4. The EP does not have 10 percent or more of their MPFS allowable charges (per TIN) for encounter codes in the measure’s denominator for dates of service from January 1, 2013 - June 30, 2013. 
5. The EP does not have prescribing privileges and reported G8644 on a billable Medicare Part B service at least once on a claim between January 1, 2013 - June 30, 2013. 

2013 Hardship Codes and Requesting Hardship Exemption

EPs and Group Practices may be exempt from 2013 payment adjustments if one of the following circumstances is applicable.

1. Inability to electronically prescribe due to state, or federal law, or local law or regulation
2. The EP prescribes fewer than 100 prescriptions during a 6-month payment adjustment reporting period
3. The EP practices in a rural area without sufficient high-speed Internet access (G8642)
4. The EP practices in an area without sufficient available pharmacies for electronic prescribing (G8643)

Submitting a Hardship Request 

CMS has established the Quality Reporting Communication Support Page for EPs to submit hardship requests, including requests associated with a G-code.

The Quality Reporting Communication Support Page User Guide provides detailed information on how to navigate within the Quality Reporting Communication Support Page.

CMS also has provided tips for using the Quality Reporting Communication Support Page.

A hardship G-code may also be submitted at least once on a claim during the 6-month 2013 eRx payment adjustment reporting period.

If applicable,

• The hardship G-code must be submitted on a claim with a billable Medicare Part B service
• The hardship G-code does not need to be submitted on a claim that contains eRx measure denominator codes

Reporting Options for Avoiding the 2013 Payment Adjustment  

Individual Eligible Professionals (EPs)-12 Month Reporting Period                                      (Dates of Service January 1, 2011 to December 31, 2011) 

Note: Successful submission of the required number of eRx events in the 12-month reporting period will allow for receipt of 2011 eRx incentive payment and allow the EP to avoid the 2013 payment adjustment.

Individual EPs-6-Month Reporting Period                                                                              (Dates of Service January 1, 2012 to June 30, 2012)  

eRx Group Practice Reporting Option (GPRO)-6-Month Reporting Option                       (Dates of Service January 1, 2012 to June 30, 2012) 

Reporting Options for Avoiding the 2014 Payment Adjustments

 Individual Eligible Professionals-12-Month Reporting Period                                        (Dates of Service January 1, 2012 to December 31, 2012) 

Note: Successful submission of the required number of eRx events in the 12-month reporting period will allow for receipt of 2012 eRx incentive payment and allow the EP to avoid the 2014 payment adjustment.

Individual Eligible Professionals-6-Month Reporting Period                                         (Dates of Service January 1, 2013 to June 30, 2013)  

Additional Information

The following links are from past CMS National Provider Calls:

February 21, 2012: CMS subject matter experts provide a brief overview on claims-based reporting for both the PQRS and eRx Incentive Program.

January 17, 2012: CMS subject matter experts provide a brief overview on how the 2012 eRx payment adjustment will appear on the remiitance advice in addition to an overview of the self nomination process.

December 20, 2011: CMS subject matter experts provide a brief overview on EHR and registry based reporting options that are available for eligible professionals participating or looking to participate in the PQRS and/or eRx Incentive Program. 

 November 8, 2011: CMS subject matter experts provide an overview of the Medicare Physician Fee Schedule to address the 2012 PQRS and the eRx Incentive Program.

Please visit the E-Prescribing Incentive Program website for more information about the eRx Incentive Program. To alert IDSA to problems that should be raised with the Centers for Medicare and Medicaid Services, please IDSA staff or call 703-299-5146.

A help line also is available to answer questions regarding participation procedures, feedback reports, and bonus payments. Please call 866-288-8912 between 7 a.m. and 7 p.m. Central Time or e-mail qnetsupport@sdps.org to access the help line.